Obtaining A PTP Order

Obtaining A PTP Order

The least complicated and vastly most successful way to obtain a court order for PTP admission is at the time of discharge following a committed hospitalization. If this has not occurred, it will be necessary  to initiate a PTP application while the individual is living in the community. 

  • Intense lobbying from family members, law enforcement and involved community health providers has proven to be highly effective in obtaining a PTP order for an individual directly upon hospital discharge.

To qualify for a progressive treatment program while living in the community, the person must be meet the criteria of ‘patient’.  In Section 7, 34-B MRSA §3801 Sub- §7, patient is defined as an individual meeting one of the following conditions:

  1. Under observation or treatment in a psychiatric or residential care facility 
  2. Receiving services from an assertive community treatment team
  3. Receiving intensive mental health management services from DHHS 
  4. BEING EVALUATED FOR EMERGENCY ADMISSION UNDER SECTION 3863 IN A HOSPITAL EMERGENCY DEPARTMENT

Furthermore, to qualify for progressive treatment plan admission, an individual must

  1. Have had at least one previous committed mental health hospitalization, defined by a diagnosis provided by a medical professional. 
  2. Suffer from a severe and persistent mental illness
  3. Pose a likelihood of serious harm either to himself/herself or others.
  4. Have the benefit of a suitable individualized treatment plan.
  5. Be unlikely to follow a mental health treatment plan, based on previous behavior.
  6. Demonstrate through past and/or present behavior that compliance with a treatment plan will enable him/her to survive more safely in a community setting without posing a likelihood of serious harm.

The immediacy of the risk of harm governs whether a request should be made for involuntary hospitalization or for treatment in the progressive treatment program.

  • If the person demonstrates imminent risk or is deemed to be likely to cause harm to himself/herself/ or others within the next 48 hours, a request is made for involuntary hospitalization.
  • If the person is likely to cause serious harm to himself/herself or others, and if this assessment is based on a past history of harmful acts following non-compliance, threats, of family, health professional and/or law enforcement observations and reports, an application for progressive treatment program would be more appropriate.

Process to initiate a PTP application directly from the community if the person has had a mental health related hospitalization within a short period of time.

  • If the person has been discharged from the hospital for a mental health related issue within a short period of time, a hospital emergency room evaluation is NOT needed. The law enforcement officer or health professional can skip the ER evaluation and proceed directly to filling out the application

Process to initiate a PTP application directly from the community if the previous hospitalization was (for example) greater than one year ago

  • If hospitalization discharge occurred greater that one year ago, the law enforcement officer/health professional must obtain a hospital emergency room evaluation PRIOR to filling out the PTP application

Process to Obtain a hospital emergency room Evaluation

  • The law enforcement officer/ health professional must contact the emergency room and describe behaviors which support the need for an emergency room evaluation to determine the need for hospitalization. Be relentless in emphasizing behaviors that justify the need for the evaluation.
  • If the emergency room personnel agree to the evaluation, the individual must be transported to the emergency room by a law enforcement officer. An emergency room evaluation is vital and must be completed prior to an application for a progressive treatment program.
  • If the evaluation concludes that involuntary hospitalization is required, the individual will be detained in the ER until an IMD hospital bed becomes available. The hospital personnel will be responsible for completing and submitting involuntary hospitalization paperwork to the district court, and a judge will determine if involuntary hospitalization is warranted.
  • If the evaluation concludes that the individual does not meet criteria for involuntary hospitalization, an application may then be completed by the law enforcement officer or a medical/mental health provider for admission to a progressive treatment program.

 An evaluation saying that hospitalization is not needed allows the officer/health professional to complete the PTP application.

Process for completing the PTP application

  • The law enforcement officer or medical/mental health provider completes the application for progressive treatment. He/She also completes a Client Rights Form and presents these forms and information to the individual and his/her guardian and/or attorney.
  • The person completing the application must inform the person with serious mental illness of his/her right to retain an attorney and to identify an independent evaluator
  • The person completing the application must find a medical provider to complete the Practitioner’s Application Certificate which states that the individual suffers from a severe and persistent mental illness, provides a mental illness diagnosis and states the likelihood of mental health deterioration and the likelihood of serious harm.
  • The person initiating the application submits the completed application, Client Notice Form, signed by the individual and verifying that he/she has been informed, and the Practitioner’s Application Certificate to the district court.
  • The person initiating the application then contacts an attorney who agrees to take the case.
  • The first $800 of attorney fees incurred by any non-state agency initiating PTP’s will be reimbursed by the state. Law Enforcement may reach out to the local district attorney for further reimbursement.

Court Hearing Process

  • Once all paperwork has been submitted, a hearing is held within 14 days.
  • Prior to the hearing, the attorney
  • Schedules a mental health evaluation by a State of Maine Independent Evaluator and ensures its completion prior to the hearing.
  • Organizes all necessary testimony in writing and in person
  • Secure housing, if needed
  • Locates a case manager, ACT team or psychiatric group home able to support the individual while in the progressive treatment program.
  • It is necessary that the law enforcement officer/health provider and all professionals and family members involved with the person with serious mental illness provide testimony to the attorney as to exactly why a PTP is necessary.
  •  If possible, all involved professionals and family members should attend the court hearing and provide testimony.

PTP Non-Compliance Process- Green Paper 

Once an individual has been court-ordered into a PTP, treatment compliance is mandatory. Non-compliance results in hospitalization. In the case of non-compliance while an individual is mandated in a PTP:

  • The professional overseeing the individual’s PTP program (intensive case manager, ACT team member, or group home manager) contacts the attorney who advocated for the PTP at the court hearing.
  • The intensive case manager, ACT team member, or group home manager fills out a Green Paper application for any district court judge to sign. (see PTP forms link of website: Progressive Treatment Program | Department of Health and Human Services)
  • The ACT team member or attorney contacts all Maine hospitals with mental health units to communicate the need for emergency hospitalization.
  • Law enforcement then transports the individual to the hospital.

(The average green paper stay is five days- Then the individual returns to the same PTP in the community.)

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